It accounts for one third of the subfertility. Male infertility may be caused by a wide range of factors most of which affect the quality and or quality of sperm.It encompasses issues related to ejaculation and those with Semen reports.
Broadly the causes may be :
1. Erection and Ejaculatory problems
- Erectile dysfunction (impotence) – It is the inability to get and maintain erection.
- Premature ejaculation – When ejaculation is too quick during sexual intercourse.
- Retrograde ejaculation – When sperms travel backwards and enters the bladder instead of coming out of the end of the urethra .It thereby produces no semen or only a small amount of semen or a cloudy urine and an urge to urinate after coitus.
Treatment of Erectile and Ejaculatory dysfunction is as per the cause, whether physical or psychological. For fertility related issues procedures such as Intrauterine insemination (IUI) as per the case may be of help. In cases of retrograde ejaculation, sperms can be obtained from urine post masturbation and used for treatment .
2. Semen related problems :
- Azoospermia – no sperms in semen sample.
- Oligospermia – low sperm counts.
- Oligozoospermia – low count and motility.
- Oligoteratozoospermia – low count, motility and abnormal forms.
Many factors influence the sperm counts these include :
- Environmental factors like smoking, alcohol, chemical usage, heat exposure, pollutants, pesticides,electromagnetic radiations, long standing illnesses.
- Infections like mumps, scrotal infections, parasitic infestations.
- Varicocele is the distention of the veins surrounding the testes, causing increased temperature of the testes and resulting in reduction of sperms.
- Hormonal causes like raised FSH suggestive of testicular failure.
Genetic causes like Yq deletions, Klinefelter’s syndrome.
At AARUSH IVF AND ENDOSCOPY CENTRE , we offer in house complete evaluation of the Male partner and treatment as per the diagnosis. Also the entire range of diagnostic and operative facilities for male subfertility is available.
Semen Analysis is a single most tool to assess male fertility. A semen sample produced by masturbation with a abstinence gap of 2-5 days is assessed for the following parameters: Count – number of sperms, Motility – movement of sperms, Morphology – percentage of sperms with normal shape, vitality – ability to live.
Other Investigations in Male Infertility
As per the case at times hormonal tests may be indicated, specialized Sperm Function tests, genetic tests are also available.
TESA : Testicular sperm Aspiration – It is a minor procedure done under sedation when there is obstructive azoospermia where sperms are found easily. The sperms so extracted can be frozen for use later or ICSI can be done if wife has undergone egg retrieval procedure.
TESE : It is an invasive procedure used to localize perm in Non-obstructive Azoospermia or testicular failure where sperms are likely to be missed in conventional aspiration procedures. In this procedure the testes are surgically opened , tissue is inspected under microscope and search is made in every part of the testicle to locate areas which may contain sperms. These sperms so obtained are used for ICSI.
PESA : Percutaneous Epididymal Sperm Aspiration is a technique specially utilized in cases where no sperm is seen in the ejaculated semen due to obstruction of the vas deferns. Sperms can be obtained from the structure called as Epididymus which is present on the posterior lateral aspect of the testes by needle aspiration if preoperative assessment of the cause of azoospermia is obstructive.
The procedure is usually performed just prior to the woman’s oocyte collection (on the same day) and the sperms so retrieved are used for ICSI or frozen for use later.
It is a microsurgical procedure done for varicocele. The swollen veins around the testes (pampiniform plexus) are tied off while preserving the normal blood vessels. This procedure is indicated in males with low sperm counts due to clinically apparent varicocele.